Abstract
BackgroundAs several new tibial osteotomy plates recently appeared on the market, the aim of the present study was to compare mechanical static and fatigue strength of three newly designed plates with gold standard plates for the treatment of medial knee joint osteoarthritis.MethodsSixteen fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO) according to standard techniques, using five TomoFix standard plates, five PEEKPower plates and six iBalance implants. Static compression load to failure and load-controlled cyclic fatigue failure tests were performed. Forces, horizontal and vertical displacements were measured; rotational permanent plastic deformations, maximal displacement ranges in the hysteresis loops of the cyclic loading responses and dynamic stiffness were determined.ResultsStatic compression load to failure tests revealed that all plates showed sufficient stability up to 2400 N without any signs of opposite cortex fracture, which occurred above this load in all constructs at different load levels. During the fatigue failure tests, screw breakage in the iBalance group and opposite cortex fractures in all constructs occurred only under physiological loading conditions (<2400 N). The highest fatigue strength in terms of maximal load and number of cycles performed prior to failure was observed for the ContourLock group followed by the iBalance implants, the TomoFix standard (std) and small stature (sm) plates. The PEEKPower group showed the lowest fatigue strength.ConclusionsAll plates showed sufficient stability under static loading. Compared to the TomoFix and the PEEKPower plates, the ContourLock plate and iBalance implant showed a higher mechanical fatigue strength during cyclic fatigue testing. These data suggest that both mechanical static and fatigue strength increase with a wider proximal T-shaped plate design together with diverging proximal screws as used in the ContourLock plate or a closed-wedge construction as in the iBalance design. Mechanical strength of the bone-implant constructs decreases with a narrow T-shaped proximal end design and converging proximal screws (TomoFix) or a short vertical plate design (PEEKPower Plate). Whenever high mechanical strength is required, a ContourLock or iBalance plate should be selected.
Highlights
As several new tibial osteotomy plates recently appeared on the market, the aim of the present study was to compare mechanical static and fatigue strength of three newly designed plates with gold standard plates for the treatment of medial knee joint osteoarthritis
Before the final collapse there were crack formations observed in the cases of the TomoFix std 1 (Fig. 10) and PEEKPower 2 (Fig. 11)
The lateral displacement (LS) was always positive and its absolute value remained greater than the medial displacement
Summary
As several new tibial osteotomy plates recently appeared on the market, the aim of the present study was to compare mechanical static and fatigue strength of three newly designed plates with gold standard plates for the treatment of medial knee joint osteoarthritis. High tibial osteotomy (HTO) is a well-established method for the treatment of unicompartmental varus gonarthrosis. Both lateral closing and medial opening techniques exist to produce a valgus alignment (Staubli 2008; Staubli and Jacob 2010). The latter is becoming increasingly popular when performed in a biplanar fashion. Since the introduction of long and rigid-angle stable plates, the frequency of non-unions after an open-wedge HTO has declined significantly (Staubli and Jacob 2010). Clinical results after HTO often are encouraging some factors associated with a poor long-term outcome such as imprecise osteotomy or loss of the primary correction angle due to poor primary fixation stability of the implant (Spahn et al 2006; Pornrattanamaneewong et al 2012)
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